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Handbook of Fractures TP > Periprosthetic Fractures > Flashcards

Periprosthetic Fractures Flashcards

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1
Q

incidence of intraoperative femoral shaft fractures in total hip arthroplasty

A

0.8% to 2.3%

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2
Q

incidence of postoperative femoral shaft fractures in total hip arthroplasty

A

0.1%

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3
Q

do femoral shaft fractures occur more frequently with noncemented or cemented components

A

noncemented

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4
Q

risk factors for femoral shaft fractures in total hip arthroplasty (8)

A

osteopenia, rheumatoid arthritis, tha following failed orif, stress risers secondary to cortical defects, revision surgery, inadequate implant site preparation, pericapsular pathology (inadequate releases), loose components

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5
Q

what percentage of femoral shaft fractures in total hip arthroplasty are caused by loose femoral components

A

33%

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6
Q

surgical considerations to avoid periprosthetic fracture during revision surgery (6)

A

longer-stem prosthesis (spanning twice the bone diameter beyond the defect), bone grafting, strut allograft or plate support, cortical windows in anterolateral location on femur in line with neutral bending axis, leave cortical windows <30% of bone diameter, choose correct starting point for reaming and broaching

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7
Q

johansson periprosthetic femoral shaft fracture type 1 (location and stem status)

A

fracture proximal to the prosthetic tip with the stem remaining in the medullary canal

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8
Q

johansson periprosthetic femoral shaft fracture type 2 (location and stem status)

A

fracture extending beyond the distal stem with dislodgement of the stem from the canal

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9
Q

johansson periprosthetic femoral shaft fracture type 3 (location)

A

fracture entirely distal to the tip of the prosthesis

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10
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 1

A

explosion type with comminution around the stem; prosthesis always loose and fracture inherently unstable

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11
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 2

A

oblique fracture around the stem; fracture pattern stable, but prosthetic loosening usually present

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12
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 3

A

transverse fracture at the distal tip of the stem; fracture unstable, but prosthetic fixation usually unaffected

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13
Q

coke and newman (modification of bethea et al.) periprosthetic femoral shaft fracture type 4

A

fracture entirely distal to the prosthesis; fracture unstable, but prosthetic fixation usually unaffected

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14
Q

aaos classification periprosthetic femoral shaft fracture level 1

A

proximal femur distally to the lower extent of lesser trochanter

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15
Q

aaos classification periprosthetic femoral shaft fracture level 2

A

10 cm of the femur distal to level 1

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16
Q

aaos classification periprosthetic femoral shaft fracture level 3

A

covers remainder of femur distal to level 2

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17
Q

aaos classification periprosthetic femoral shaft fracture type 1

A

fracture proximal to the intertrochanteric line that usually occurs during dislocation of the hip

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18
Q

aaos classification periprosthetic femoral shaft fracture type 2

A

vertical or spiral split that does not extend past the lower extent of the lesser trochanter

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19
Q

aaos classification periprosthetic femoral shaft fracture type 3

A

vertical or spiral split that extends past the lower extent of the lesser trochanter but not beyond level 2, usually at the junction of the middle and distal thirds of the femoral stem

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20
Q

aaos classification periprosthetic femoral shaft fracture type 4

A

fractures that traverse or lie within the area of the femoral stem in level 3, with type 4a being a spiral fracture around the tip and type 4v being a simple transverse or short oblique fracture

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21
Q

aaos classification periprosthetic femoral shaft fracture type 5

A

severely comminuted fractures around the stem in level 3

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22
Q

aaos classification periprosthetic femoral shaft fracture type 6

A

fractures distal to the stem tip, also in level 3

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23
Q

vancouver classification periprosthetic femoral shaft fracture type a

A

fracture in the trochanteric region

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24
Q

vancouver classification periprosthetic femoral shaft fracture type ag

A

greater trochanter region

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25
vancouver classification periprosthetic femoral shaft fracture type al
lesser trochanteric region
26
vancouver classification periprosthetic femoral shaft fracture type b
fracture around or just distal to the stem
27
vancouver classification periprosthetic femoral shaft fracture type b1
stable prosthesis
28
vancouver classification periprosthetic femoral shaft fracture type b2
unstable prosthesis
29
vancouver classification periprosthetic femoral shaft fracture type b3
unstable prosthesis plus inadequate bone stock
30
vancouver classification periprosthetic femoral shaft fracture type c
well below the stem
31
treatment-dependent factors of periprosthetic femoral shaft fractures (5)
location, prosthesis stability, bone stock, age and medical condition of patient, accurate reduction and secure fixation
32
treatment options for periprosthetic femoral shaft fractures (3)
nonoperative treatment, orif, revision plus orif
33
nonoperative treatment for periprosthetic femoral shaft fractures (4)
limited weight bearing, brace, cast, or traction
34
orif options for periprosthetic femoral shaft fractures (2+/-1)
plate/screws or cable +/- strut allograft
35
choice of uncemented implants used in the treatment of vancouver type 2b periprosthetic femoral shaft fractures (3)
extensive coated long-stem curved prosthesis, flute long-stem prosthesis, modular implants
36
treatment of vancouver type c periprosthetic femoral shaft fractures (2+/-1)
treated independently of the arthroplasty (plate/screws and/or cables with or without strut allograft)
37
treatment of nondisplaced periprosthetic acetabular fractures (1)
limited weight-bearing (crutches)
38
complication associated with nondisplaced periprosthetic acetabular fractures (1)
late loosening of the acetabular component requiring revision
39
risk factor for intraoperative periprosthetic acetabular fractures
significant underreaming prior to press fit cup
40
complications associated with late periprosthetic acetabular fractures (2)
osteolysis or stress shielding
41
what must be assessed for in all periprosthetic acetabular fractures (1)
pelvic discontinuity
42
treatment of displaced periprosthetic acetabular fractures (2)
orif with component revision
43
incidence of periprosthetic supracondylar femur fractures in total knee arthroplasty in primary tka and revisions
0.6% to 2.8% in primaries, up to 6.3% in revisions
44
risk factors for periprosthetic supracondylar femur fractures in total knee arthroplasty (4)
osteoporosis, preexisting neurologic disease, knee stiffness/arthrofibrosis, notching of the anterior cortex
45
anterior notching in tka of 3 mm reduces torsional strength by what percentage
29%
46
is there a correlation between notching and supracondylar fractures in the absence of significant osteopenia
no
47
what can be done if notching >3mm is noted intraoperatively
consider stemmed implant
48
neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 1
minimally displaced supracondylar fracture
49
neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 2
displaced supracondylar fracture
50
neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 3
comminuted supracondylar fracture
51
neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 4
fracture at the type of the prosthetic femoral stem of fracture of the diaphysis above the prosthesis
52
neer classification (with modification by merkel) periprosthetic supracondylar femur fracture type 5
any fracture of the tibia
53
lewis and rorabeck classification of periprosthetic femur fractures about total knees type 1
nondisplaced fracture, and the bone-prosthesis interface remains intact
54
lewis and rorabeck classification of periprosthetic femur fractures about total knees type 2
interface remains intact, but the fracture is displaced
55
lewis and rorabeck classification of periprosthetic femur fractures about total knees type 3
patient has a loose or failing prosthesis in the presence of either a displaced or a nondisplaced fracture
56
treatment principles of periprosthetic supracondylar femur fractures (4)
anatomic/mechanical alignment critical, nondisplaced fractures may be treated nonoperatively, orif indicated if alignment unacceptable by closed means and if bone stock is adequate for fixation devices, immediate prosthetic revision is indicated in selected cases
57
nonoperative treatment of periprosthetic supracondylar femur fracture (cast type and length of treatment)
long leg casting or cast bracing for 4 to 8 weeks for minimally displaced fractures
58
options for orif stabilization of periprosthetic supracondylar femur fractures (6)
blade plate, dynamic condylar screw, dynamic compression plate, condylar buttress plate, locked plate, retrograde intramedullary nailing
59
when can primary revision with a stemmed implant be considered for the treatment of periprosthetic supracondylar femur fracture (2)
involvement of the bone-implant interface, loose prosthesis
60
treatment of periprosthetic supracondylar femur fractures around the diaphysis or tip of a femoral component (3)
cortical strut grafts and cerclage wiring, dynamic compression plate, locked plate
61
acceptable alignment guidelines for periprosthetic supracondylar femur fractures (4)
angulation <1cm shortening
62
periprosthetic tibial fracture risk factors (6)
significant trauma, tibial component malalignment associated with increased medial plateau stress fractures, revision surgery with press-fit stems to bypass a defect, loose components and osteolysis, more common with increase in unicompartmental knee replacement, pin site placement
63
three factors forming the basis of felix classification of periprosthetic tibial fractures
location, stability of implant, whether the fracture occurred intraoperatively or postoperatively
64
felix classification periprosthetic tibial fracture type 1
occur in the tibial plateau
65
felix classification periprosthetic tibial fracture type 2
adjacent to the stem
66
felix classification periprosthetic tibial fracture type 3
distal to the prosthesis
67
felix classification periprosthetic tibial fracture type 4
involve the tubercle
68
felix classification periprosthetic tibial fracture subtype a
well-fixed implant
69
felix classification periprosthetic tibial fracture subtype b
loose implant
70
felix classification periprosthetic tibial fracture subtype c
fractures are intraoperative
71
preferred treatment of periprosthetic tibial fractures
closed reduction and cast immobilization
72
indications for orif of periprosthetic tibial fractures (1)
failed closed reduction and cast immobilization
73
treatment of type 1 periprosthetic tibial fractures (1)
revision of tibial component
74
periprosthetic patella fractures postoperative incidence
0.3% to 5.4%
75
periprosthetic patella fractures risk factors (6)
large central peg component, excessive resection of patella during prosthetic implantation, lateral release with devascularization of the patella, malalignment, thermal necrosis (secondary to methylmethacrylate), excessive femoral component fixation
76
golberg classification for periprosthetic patella fractures type 1
fractures not involving cement/implant composite or quadriceps mechanism
77
golberg classification for periprosthetic patella fractures type 2
fractures involving cement/implant composite and/or quadriceps mechanism
78
golberg classification for periprosthetic patella fractures type 3a
inferior pole fractures with patellar ligament disruption
79
golberg classification for periprosthetic patella fractures type 3b
inferior pole fractures without patellar ligament disruption
80
golberg classification for periprosthetic patella fractures type 4
fracture-dislocations
81
nonoperative treatment indications for periprosthetic patella fractures (3)
fractures without component loosening, extensor mechanism rupture, or malalignment of implant (type 1 or 3b)
82
nonoperative treatment for periprosthetic patella fractures
knee immobilizer for 4 to 6 weeks, partial weight bearing on crutches
83
operative treatment indications for periprosthetic patella fractures (3)
disruption of extensor mechanism, patellar dislocation, prosthetic loosening (types 2, 3a, 4)
84
operative treatment options for periprosthetic patella fractures (3)
orif with revision of prosthetic patella, fragment excision, patellectomy
85
surgical considerations for operative treatment of periprosthetic patella fractures (4)
adequate medial arthrotomy, adequate lateral release, preservation of superior lateral geniculate artery, preservation of patellar fat pad

Handbook of Fractures TP (6 decks)

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